- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,518.41 / $1,543.03 / $3,955.04
| Facility | | $1,518.41 | $1,543.03 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.02 / $961.01 / $1,062.46
| Professional | | $676.02 | $961.01 | $1,062.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $638.08 / $883.15 / $1,391.70
| Professional | | $638.08 | $883.15 | $1,391.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $919.95 / $1,179.77 / $1,471.76
| Professional | | $919.95 | $1,179.77 | $1,471.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,401.00 / $4,915.00
| Facility | | $540.00 | $1,401.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.26 / $1,020.18 / $1,559.76
| Professional | | $630.26 | $1,020.18 | $1,559.76 |